Mississauga Halton LHIN

Governance to Governance Session

Guest Speaker:

Agenda

2

Welcome

3

Introduction of Dr Joshua Tepper

President and CEO

Health Quality Ontario

4

Dr. Joshua Tepper

Twitter: @drjoshuatepper

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Objectives

• About HQO

• CQA

• QIP

• Working with the LHIN

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Patients, Families and Public

Quality Improvement

Champion

Health System

Leaders and Managers

Front Line Clinicians

Define the

Evidence

-HTA

-Field Evaluations

-Appropriateness

-Mega-analysis

-QBP

Support Quality

-Quality Improvement Plans

-Regional Quality Hubs

-Capacity Building

-Knowledge Translation

Monitor &

Report

-Data

-Indicator/Target

-Tools

-Reporting

Values & Enablers:

Right Team & Culture - Patient/Public Engagement – Partnerships

Strong Communication - Equity

Vision:

Continually Improve the health of Ontarians

Mandate:

System Quality Framework and Facilitation

DRAFT

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Excellent Care for All: HQO’s Mandate

• HQO works in partnership with Ontario’s health care

system to support a better experience of care, better

outcomes for Ontarians and better value for money.

• HQO’s legislated mandate under the Excellent Care

for All Act, 2010 is to:

• Monitor and report to the people of Ontario on the quality of

their health care system

• Support continuous quality improvement

• Promote health care that is supported by the best available

scientific evidence

www.HQOntario.ca

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Excellent Care for All: HQO’s Mandate

• Within the domain of monitoring and reporting, ECFAA

identifies four areas of focus:

1. Access to publicly funded health services,

2. Health human resources in publicly funded health services,

3. Consumer and population health status, and

4. Health system outcomes

www.HQOntario.ca

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Excellent Care for All: The Common Quality Agenda

“The people of Ontario and their Government share a vision for

a Province where excellent health care services are available to

all Ontarians, where professions work together, and where

patients are confident that their health care system is providing

them with excellent health care” (preamble, ECFAA).

COMMON QUALITY AGENDA

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HQO’s Strategic Objective

“Ontario’s move to a high-quality, evidence-based

healthcare system must be grounded in a clear and

common set of provincial priorities, goals, tactics and

measures. The whole system must begin to move in a

common direction, a move that requires a common

quality agenda” (HQO Strategic Plan 2012, page 11)

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The Common Quality Agenda

A system-wide initiative informed by three goals:

1. Focus the health care system on a small number of priority

areas for quality improvement

2. Leverage performance reporting as a mechanism for

improvement

3. Improve quality through partnership

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How Did CQA Indicators Get Selected?

HQO Suite of Reported Indicators

Government Priorities

Sector- Specific

Valid

Available & Stable Data

CQA

Cross-System

Integration

Indicator Selection Consultation Process

Environmental Scan/Review of

Ministry Priorities

Engagement with ICES scientists and exploratory

conversations with system partners

Comprehensive partner engagement (sector-specific and

cross-sector indicators & targets)

Partner engagement for

ongoing refinement of key performance indicators & targets

March 2013 April – August 2013

• HQO has undertaken a methodical process to identify indicators for

CQA, beginning with identification of and alignment with government

priorities for the health system.

September – October 2013

• Partner engagement for feedback on the interpretation of

performance results will be an ongoing, continuing partnership

process with the health system.

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2014

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How CQA Relates to Other HQO and

System Indicators

CQA

“Deep Dive”

Sector-Specific & Integration

Other

Other – Not in Ontario

HQO

Reported

The HQO

Suite of

Indicators

HQO

Supported

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About CQA

• CQA is an ongoing approach to support the system

and quality improvement

• The selected indicators are not intended to be a

reflection of the full scope of an individual sector or

profession

• CQA results are not intended to be a statement about

the overall quality of the system

• A focus on targets is a key element of the CQA

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The Indicators

Please refer to the

common quality agenda

indicator “poster” and target table

How Does CQA Align with Health Links

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Health Links Indicators Alignment with CQA

Development of coordinated care plans for all No

Complex patients and seniors with regular and timely access to primary care

Yes

Reduce time from primary care to specialist consultation

Yes (for select consultations/ conditions)

Reduce number of 30 day readmissions to hospital Yes

Reduce number of avoidable ED visits for patients with conditions best managed elsewhere

No (CQA reports admission and readmission rates)

Reduce time from referral to home care visit Yes

Reduce unnecessary admission to hospital Yes

Ensure primary care follow-up within seven days of discharge from an acute care setting

Yes (for select conditions)

Enhance the health system experience for patients with greatest health care needs

Yes, with patient experience/ satisfaction survey

data by sector (where available) PC: No, Year 1 (Yes, Year 2 and on-going)

Achieve ALC of 9% or less Yes

Reduce average cost of delivering health services to patients without compromising the quality of care

No

How Does CQA Align with Acute QIPs

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QIP Indicators Alignment with CQA

CDI rate per 1,000 patient days (core) Yes

Total Margin: Percent by which total corporate (consolidated)

revenues exceed or fall short of total corporate (consolidated)

expense, excluding the impact of facility amortization, in a

given year (core)

No

ER Wait times: 90th Percentile ER length of stay for Admitted

patients (core) Yes (slightly revised)

Readmission within 30 days for selected CMGs to any facility

(core) Yes (slightly revised)

Percent ALC days: total number of inpatient days designated

as ALC, divided by the total number of inpatient days (core) Yes

Would you recommend this hospital to your friends and

family? (core)

Yes

Overall, how would you rate the care and services you

received at the hospital (core)

No

Rate of in-hospital mortality following major surgery No

Surgical Safety Checklist No

How Does CQA Align with Acute QIPs

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QIP Indicators Alignment with CQA

Medication reconciliation at admission: No

Hospital specific mortality ratio No

Hand hygiene compliance before patient contact No

VAP rate per 1,000 ventilator days No

Rate of central line blood stream infections No

Percent of complex continuing care residents with new

pressure ulcer in the last three months (stage 2 or higher) Yes

Percent of complex continuing care residents who fell in the

last 30 days Yes

Physical restraint use in mental health admission Yes

How Does CQA Align with PC QIPs

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QIP Indicators Alignment with CQA

Timely access to primary care, when needed (Priority theme) Yes

Primary care visits post-discharge (Priority theme)

Yes, year 1: 7 day physician follow-up post

discharge (for mental health, COPD, heart

failure)

Yes, year 2 and on-going: Health Experience

Survey data (MOHLTC-HAB data)

Patient experience (Priority theme)

• Opportunity to ask questions

• Patient/client engagement

• Having enough time

No, Year 1 (Yes, Year 2 and on-going)

Percent of patients/clients who visited the Emergency

Department (ED) for conditions best managed elsewhere

(Optional indicator)

No (CQA reports admission and readmission

rates)

Hospital readmission within 30 days for selected CMGs

(Optional indicator) Yes

Percent of patient/client population over 65 that received

influenza immunizations(Optional indicator) Yes

Percent of patient/client population who are up-to-date in

cancer screening (Optional indicator) Yes

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How Does CQA Align with QBPs

QBP CQA* QBP CQA*

Stroke Yes Cataract No

CHF Yes

Non-cardiac Vascular No

COPD Yes

Chronic Kidney

Disease

No

Hip Fracture No Endoscopy No

Hip and Knee

Replacement

Yes Systemic treatment Yes

Pneumonia No *Minimum one CQA

indicator

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How Does CQA Align with LHIN

Accountability Agreements

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LHIN Indicator Type* Number of LHIN

Indicators

Number Aligned

with CQA

MLPA Performance Indicators 15 8

H-SAA 18 7

L-SAA 2 0

M-SAA 24 8

*Does not include Explanatory or LHIN-specific indicators

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How Does CQA Align with the

PCPM Framework

www.HQOntario.ca

Access

Extent of (avoidable) emergency department, walk-in clinic, urgent care centre use *(Integration)

Access to a regular primary care provider

Access to an inter-professional primary care team

Timely access at regular place of care

Access to after-hours care (telephone and in-person)

Access to non face-to-face care (e.g., telephone, email, etc.)

Access to home visits for target populations

Patient access to their

own health information

*(Efficiency)

Information sharing across the continuum of care including patients and family caregivers

Care coordination with other health and community care providers and services *(Efficiency and Patient-Centredness)

Time to referred appoint-ment with medical/surgical specialist or other specialized services *(Access)

Hospital admissions and readmissions*(Effectiveness)

Follow-up with regular primary care provider post hospital discharge

Waiting time for community services

Primary care providers’ access

to specialist advice via

telephone, email, etc.

Time to referred diagnostic

test (e.g., CAT scan, MRI, etc.)

Shared care arrangements for

patients to see a specialist in

their regular primary care

setting

Per capita health care cost (primary care, specialist care, hospital care, diagnostics, pharmaceuti-cals, long-term care, community care)

Support for family caregivers

Unnecessary duplication of diagnostic tests/imaging

Implementation and meaningful use of Electronic Medical Records/Electronic Health Records *(Integration)

Self management support and collaboration with patients and families *(Patient-Centredness and Effectiveness)

Patient wait times in office

Extent of generic prescribing

Management of chronic conditions including people with mental health and addictions and multiple chronic conditions

Advanced disease/palliative care

Symptom management*(Patient-Centredness)

Negotiated care plan for patients with chronic conditions*(Patient-Centredness)

Shared clinical

decision-making

*(Patient-Centredness)

Preventive care for infants and children (beyond immunization)

Health and socio-demographic information about the population being served (including health status)

Immunization through the life span

Screening and manage-ment of risk factors for cardiovascular disease and other chronic conditions. (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteris-tics, sexual and other high risk behaviours) *(Effectiveness)

Chronic disease screening (e.g. cancer, diabetes, hypertension, asthma, depression, dementia) *(Effectiveness)

Prenatal care

Infection prevention and control

Medication management, including medication reconciliation

Recognition and management of adverse events including medical errors

Injury prevention

*(Focus on Population

Health)

Respect for patients’ and families' values, culture, needs and goals

Process to obtain patient/client and care-giver input regarding health care services

Respectful and under-standable communication with patients

Coordination of care within the primary care setting

Process for addressing suggestions/ complaints

Privacy and

confidentiality

Funds received by primary care practices (by category)

Human resources availability, composition (skills mix) and optimized scope of practice

Healthy work environment and safety

Funding and use of electronic systems to link with other settings *(Integration)

Practice improvement and planning

Human resources training and professional develop-ment, including patient- and family- centred care

Provider remuneration

methods

Total cost of care

*(Efficiency)

Availability of information

technology systems

Information technology

investment and expenditure

Provider satisfaction

(employee engagement

culture)

Integration Efficiency Effectiveness

Equity

Focus on Population Health

Safety Patient-Centredness Appropriate Resources

Equity is a cross cutting domain and will be assessed in relation to a variety of economic and social variables such as income, education, gender, urban/rural location, age, sexual orientation/identity , language, immigration, ethno-cultural identity and Aboriginal status.

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= Also relevant to mentioned domain

= Measurement area for future consideration

= System level priority

= System & Practice level priority

= Practice level priority

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CQA Reporting

HQO is engaging with partners on key questions that will

shape CQA reporting:

• At what level should CQA indicators be reported?

• What criteria should be used to determine reporting

level?

• What criteria should be used to decide whether

organization-level reporting should be anonymous or

not?

• What can we do to increase the timeliness of data

access and reporting?

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Next Steps: Plan for 2014

• Continue MOH/LHIN/HQO/ PHO/CCO discussions to

align indicators

• HQO to develop an overall performance monitoring

and reporting strategy that includes CQA

• Ongoing refinement of CQA:

– Conceptual framework

– Indicator selection

– Target setting

QUALITY IMPROVEMENT

PLANS

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Quality Improvement Plans

Very successful

but

Time to reflect

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PARTNERING WITH THE LHIN

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bestPATH

• Services/tools offered:

– Educate and mentor Health Link leaders and teams in QI

science, application, change management, and team building

– Guide teams through the HQO Quality Improvement

Framework (a systematic approach to process improvement)

– Value stream analysis events

– Implementation of evidence informed improvement packages

– Experience based patient and family co-design

– Connect teams with experts and innovators

– Web-based repository of best practices

– Data analysis e.g. defining patient population

– Best practice implementation

– Access to IHI Open School

www.HQOntario.ca

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bestPATH

Active in 33 Health Links in 11 LHINs

28 system level Value Stream Analysis (VSA) events with 670 participants

resulting in:

• Shared visions for the Health Links

• Identification of opportunities for improvement

• Action plans developed and incorporated in business plans

• Tests of change initiated

• 5 Improvement Facilitator (IF) Education Sessions preparing 147 IFs

• IF Community of Practice developed in ESC LHIN

• 10 Patient Engagement workshops

• Advanced Access supporting Health Links in two LHINs

www.HQOntario.ca

33 www.HQOntario.ca

bestPATH Reach Legend

VSA (28)

(670 participants)

IF Training

(6 LHINs)

147 IFs

prepared

Patient

Engageme

nt

Workshop

s (10)

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Transition Planning Guide

www.HQOntario.ca

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Transition Planning

• Feedback so far:

– “This document captures the things that are required when looking at the

issue of good, effective discharge planning. We very much appreciate the

parts of the document that address patient understanding of each facet of the

plan, particularly the inclusion of the ‘teach back’ method… it is an effective

technique.”

– OMA

– “This document and the development of best practice goals for discharge

planning are essential steps in improving the coordination and integration of

care for our complex patients.”

– AFHTO

– “We are pleased the framework is a patient-centred guide to help transition

care after acute needs have been met.”

– OHA

www.HQOntario.ca

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Coordinated Care Planning

• Partnered with e-Health Liaison and Special Projects Branches in

development of the business case for an electronic “solution” to

coordinated, individualized plans of care; continuing to support working

groups to advance best practices in coordinated care planning and

patient engagement

HQO’s contribution to this process has focused most on:

• Identifying leading practices in care planning through literature review

and emerging trends

• Keeping the focus on a patient-centred approach

• Emphasizing the need for a patient portal

www.HQOntario.ca

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Coordinated Care

Plan

www.HQOntario.ca

• Example of the short form

front page

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Other Supports

• Quality Improvement Plans - opportunity for collaboration

through aligned QIPs

• IDEAS - applied learning opportunity to build capacity within

Health Links

• QI RAP is a flexible and scalable, web-based measurement

and management tool to support improvement work

• Performance measurement collaboration

• Evidence-based practices; continuously renewable resource

• QI compass

www.HQOntario.ca

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Future HQO work in QI that will

further support LHINS and their HCP

• Shift to Regional Model focused on system level cross-sector work,

spread and scale

• In collaboration with system partners, establish communities of

practices that link local and provincial resources to help with

implementation, spread and sustainability

• Increased patient, family, caregiver engagement for improved

experience and outcomes

• Increased Clinical Engagement

• Regionally based QI and KTE Specialist support to help Health

Links customize innovations, implement evidence based practices,

achieve common quality agenda targets and other aligned

improvement efforts

www.HQOntario.ca

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Many opportunities

• Evidence creation and dissemination

• Partnership on CQA and other indicator/reporting work

• Clin

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If we have time and wifi

• Nothing About Me Without Me

• Failure is the only option

www.HQOntario.ca

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Thank you and

Conversation

@drjoshuatepper

Break

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Minister’s Medal

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Mississauga Halton LHIN Board

Quality Committee

Quality Committee Charter

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Mandate

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•

•

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Quality

Committee

Charter

Includes Health Quality

Ontario’s definition of 9

attributes of a quality

healthcare system

Quality Attributes

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Selection of Patient Centered Indicators

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The Change Model

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Five key principles in using the Change Model

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Quality Committee Shared Purpose

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Leadership for Change

Spread of Innovation

Improvement Methodology

Rigorous Delivery

Transparent Measurement

System Drivers

Engagement To Mobilize Our

Shared Purpose

Quality

Committee is

starting with the

elements:

Leadership for Change

Transparent

Measurement

Engagement to

Mobilize

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Transparent Measurement

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Pending – April 2014

Pending – April 2014

Leadership for Change

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G2G Component of the Quality Committee:

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Quality Improvement Plans (QIPs)

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Engagement to Mobilize

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Health System Governance Challenges Identified

by the Centre for Healthcare Governance

Systems Level Quality

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Facilitated Discussion

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Background

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Activity

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Closing Remarks

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Community Governance Consultation Group

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Community Governance

Consultation Group

Thank you for attending

tonight’s session

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